Evidence map›Paper›PMID 36820100›Full record

ArticleEClinicalMedicine2023

Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial.

Chen Chen, Menglu Ouyang, Sheila Ong, Luyun Zhang, Guobin Zhang, Candice Delcourt, Grant Mair, Leibo Liu, Laurent Billot, Qiang Li and 20 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01422616 (An International Randomised Controlled Trial to Establish the Effects of Low-dose rtPA and the Effects of Early Intensive Blood Pressure Lowering in Patients With Acute Ischaemic Stroke), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.1field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01422616 phase3completednot on this map

An International Randomised Controlled Trial to Establish the Effects of Low-dose rtPA and the Effects of Early Intensive Blood Pressure Lowering in Patients With Acute Ischaemic Stroke

TypeinterventionalSponsorThe George InstituteRan2012 to 2018Enrolled4,587ConditionsIschemic Stroke, High Blood PressureArmsLow-dose rtPA, Standard-dose rtPA, Intensive blood pressure (BP) lowering, BP management policies
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Observational
  2. Hemorrhagic Conversion of Acute Ischemic Stroke.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

30 authors at 17 institutions in 8 countries.

Chen ChenNeurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Menglu OuyangThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Sheila OngThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Luyun ZhangThe George Institute for Global Health China, Beijing, China.
Guobin ZhangThe George Institute for Global Health China, Beijing, China.
Candice DelcourtThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Grant MairDivision of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Centre in the UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
Leibo LiuThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Laurent BillotThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Qiang LiThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Xiaoying ChenThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Mark ParsonsIngham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia.
Joseph P BroderickDepartments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
Andrew M DemchukCalgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Philip M BathStroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.
Geoffrey A DonnanMelbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
Christopher LeviNeurology Department, John Hunter Hospital, and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.
John ChalmersThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Richard I LindleyUniversity of Sydney, Sydney, Australia.
Sheila O MartinsStroke Division of Neurology Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Octavio M Pontes-NetoStroke Service - Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, SP, Brazil.
Paula Muñoz VenturelliThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Verónica OlavarríaFacultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
Pablo LavadosFacultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
Thompson G RobinsonDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Leicester, UK.
Joanna M WardlawDivision of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Centre in the UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
Gang LiNeurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Xia WangThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Lili SongThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
Craig S AndersonThe George Institute for Global Health, University of New South Wales, Sydney, Australia.
UNSW Sydney · AUUniversidad del Desarrollo · CLUK Dementia Research Institute · GBJohn Hunter Hospital · AULiverpool Hospital · AUMinistry of Health and Welfare · KRNIHR Leicester Biomedical Research Centre · GBShanghai East Hospital · CNShanghai Jiao Tong University · CNShenyang First People's Hospital · CNThe Royal Melbourne Hospital · AUThe University of Sydney · AUUniversidade de Ribeirão Preto · BRUniversidade Federal do Rio Grande do Sul · BRUniversity of Calgary · CAUniversity of Cincinnati Medical Center · USUniversity of Nottingham · GB

Funding

Medical Research Council MC_G1002455
6 · The paper itself

Abstract

Background: Intensive blood pressure lowering may adversely affect evolving cerebral ischaemia. We aimed to determine whether intensive blood pressure lowering altered the size of cerebral infarction in the 2196 patients who participated in the Enhanced Control of Hypertension and Thrombolysis Stroke Study, an international randomised controlled trial of intensive (systolic target 130-140 mm Hg within 1 h; maintained for 72 h) or guideline-recommended (systolic target <180 mm Hg) blood pressure management in patients with hypertension (systolic blood pressure >150 mm Hg) after thrombolysis treatment for acute ischaemic stroke between March 3, 2012 and April 30, 2018. Methods: All available brain imaging were analysed centrally by expert readers. Log-linear regression was used to determine the effects of intensive blood pressure lowering on the size of cerebral infarction, with adjustment for potential confounders. The primary analysis pertained to follow-up computerised tomography (CT) scans done between 24 and 36 h. Sensitivity analysis were undertaken in patients with only a follow-up magnetic resonance imaging (MRI) and either MRI or CT at 24-36 h, and in patients with any brain imaging done at any time during follow-up. This trial is registered with ClinicalTrials.gov, number NCT01422616. Findings: There were 1477 (67.3%) patients (mean age 67.7 [12.1] y; male 60%, Asian 65%) with available follow-up brain imaging for analysis, including 635 patients with a CT done at 24-36 h. Mean achieved systolic blood pressures over 1-24 h were 141 mm Hg and 149 mm Hg in the intensive group and guideline group, respectively. There was no effect of intensive blood pressure lowering on the median size (ml) of cerebral infarction on follow-up CT at 24-36 h (0.3 [IQR 0.0-16.6] in the intensive group and 0.9 [0.0-12.5] in the guideline group; log Δmean -0.17, 95% CI -0.78 to 0.43). The results were consistent in sensitivity and subgroup analyses. Interpretation: Intensive blood pressure lowering treatment to a systolic target <140 mm Hg within several hours after the onset of symptoms may not increase the size of cerebral infarction in patients who receive thrombolysis treatment for acute ischaemic stroke of mild to moderate neurological severity. Funding: National Health and Medical Research Council of Australia; UK Stroke Association; UK Dementia Research Institute; Ministry of Health and the National Council for Scientific and Technological Development of Brazil; Ministry for Health, Welfare, and Family Affairs of South Korea; Takeda.

Indexed as

Acute ischaemic strokeBlood pressureBrain imagingCerebral infarctionClinical trialThrombolysis

Identifiers

PMID36820100
PMCPMC9938155
OpenAlexW4320928737

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.